心血管疾病合并糖代谢异常的幻灯片.pptVIP

图中所示为两个不同个体的血糖变化情况。尽管二人的平均血糖水平和血红蛋白水平均一致，但其血糖波动情况则相差较大。 HbA1c仅反映平均血糖水平，不能反映血糖变化的全貌。 对心血管疾病患者的降糖药，降了要有效降糖以外,我们最重视的就是其安全性 为明确强化降糖与心血管事件的关系，对21名CAD合并2型DM的患者进行72小时的血糖及Holter监测，记录心脏缺血和低血糖事件。 结果记录到19名患者令人满意的连续血糖结果，共54次低血糖和59次高血糖，低血糖事件中的10次与胸痛症状相关联，而高血糖出现时仅有1次出现胸痛，血糖正常时则无胸痛症状出现。结论提示低血糖患者性藏缺血事件明显高于血糖正常及高血糖者。 OBJECTIVE— In some studies intensive diabetes treatment in patients with type 2 diabetes may be associated with increased cardiovascular events. It is not clear whether these events are related to hypoglycemic episodes. To determine whether episodes of hypoglycemia were more likely to be associated with cardiac ischemia than normoglycemia or hyperglycemia, we carried out a study in 21 patients with coronary artery disease (CAD) and type 2 diabetes treated with insulin who had good glycemic control. RESEARCH DESIGN AND METHODS— We carried out 72-h continuous glucose monitoring along with simultaneous cardiac Holter monitoring for ischemia. Patients also recorded symptoms of cardiac ischemia (chest pain) and symptoms of hypoglycemia. RESULTS— Satisfactory continuous glucose monitoring system recordings were obtained in 19 patients. We recorded 54 episodes of hypoglycemia (blood glucose 70 mg/dl; 26 of these were symptomatic) and 59 episodes of hyperglycemia (blood glucose 200 mg/dl; none symptomatic). Of the 54 episodes of hypoglycemia, 10 were associated with symptoms of chest pain, during 4 of which electrocardiographic abnormalities were documented. In contrast, only 1 episode of chest pain occurred during 59 episodes of hyperglycemia. No chest pain or electrocardiographic abnormalities occurred when the blood glucose was within the normal range. The difference between the frequency of ischemia during hypoglycemia and the frequency during both hyperglycemia and normoglycemia was statistically significant (P 0.01). There were 50 episodes during which the blood glucose changed by 100 mg over a 60-min period, and ischemic symptoms occurred during 9 of these episodes (P